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32 Cards in this Set
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Antidepressants |
TCAs, MAOIs, SSRIs, Atypical antidepressants All equally effective but have different safety and side effects |
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TCAs |
Inhibit reuptake of NE and serotonin, increasing the availability in the synapse Have increased incidence of SE, require greater monitoring and can be lethal in overdose
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Mainstay in treatment of TCA overdose |
IV sodium bicarbonate |
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Side Effects of TCAs |
*Anti-HAM *Hallmark is widened QRS (>100msec) Antihistaminic-sedation Antiadrenergic-CV-orthostatic hypotension, tachycardia, arrhythmias, Anti-muscarinic- dry mouth, constipation, urinary retention, blurred vision, tachycardia Wt Gain, lethal in overdose 3 C's- Convulsions, coma, cardiotoxicity
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Examples of TCAs |
Imipramine (tofranil) Amitryptiline (Elavil) Trimipramine (Surmontil) Nortriptyline (Pamelor)- Least to cause orthostatic hypotension Desipramine (Norpramin)- least sedating, least anticholinergic Clomipramine (anafranil)- most serotonic specific- OCD Doxepin (Sinequan) |
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MAOIs |
Prevent inactivation of biogenic amines (NE, Serotonin, dopamine, tyramine) Very effective for refractory depression and in refractory panic disorder
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Side Effects of MAOIs |
Common- orthostatic hypotension, drowsiness, wt gain, sexual dysfunction, dry mouth, sleep dysfunction Serotonin syndrome Hypertensive crisis- MAOIs are taken with tyramine rich food or sympathomimetics, cause a build up of stored catecholamines |
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Serotonin syndrome |
D/C meds! occurs when SSRIs and MAOIs are taken together Sx's: lethargy, restlessness, confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma and death. |
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Examples of MAOIs |
Phenelzine (Nardil) Tranylcypromine (Parnate) Iscarboxazid (Marplan) |
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SSRIs |
Inhibit presynaptic serontonin pumps--> increased availability of serotonin in synaptic clefts low incidence of side effects, no food restrictions, much safer in overdose Also used to tx some anxiety disorders, OCD and premenstrual dysphoric disorder |
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Side effects of SSRIs |
Low since they don't act on histamine, adrenergic, or muscarinic receptors Sexual dysfunction GI Insomnia Head ache Anorexia/weight loss Serotonin syndrome |
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Examples of SSRIs |
Fluoxetine (Prozac)- longest half life- no need to taper Sertraline (Zoloft)- increased risk for GI disturbances Paroxetine (Paxil)- Most serotonin specific- stimulant Fluvoxamine (Luvox)- only approved for use in OCD Citalopram (Celexa) Escitalopram (Lexapro)- fewer side effects, more expensive |
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SNRIs |
Venlafaxine (effexor)- refractory depression, low drug interaction potential, SE's similar to SSRIs, can increase BP |
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NDRIs |
Buproprion (Wellbutrin)- smoking cessation, SAD and adult ADHD, lack of sexual side effects, can exacerbate psychosis, increased risk of seizures |
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SARIs |
Nefazodone (Serzone) and Trazodone (Desyrel)- refractory major depression, major depression with anxiety and insomnia Side Effects: nausea, dizziness, orthostatic hypotension, cardiac arrhythymias, sedation and priapism |
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NASAs |
Mirtazapine (Remeron)- refractory major depression (especially in patients that need to gain weight) SE: sedation, weight gain, dizziness, somnolence, tremor, agranulocytosis |
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Antipsychotics |
Traditional- classified according to potency; work by blocking dopamine receptors Atypical- block both dopamine and serotonin receptors- effect on dopamine is weaker so lower side effects |
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Traditional antipsychotics-low potency |
Have lower affinity for dopamine receptors, higher dose required Chlorpromazine (thorazine) Thioridazine (Mellaril) Increased incidences of anticholinergic and antihistaminic SE Decreased incidences of extrapyramidal SE and NMS |
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Traditional antipsychotics- high potency |
Greater affinity for dopamine receptors, low dose needed Haloperidol (Haldol)- LA available- IM x 4-5 weeks Fluprienazine (Prolixin)- LA available- IM x 2-3 weeks Trifluoperazine (Stelazine) Perphenazine (Trilafon) Pimozide (Orap) Increased incidences of EPSE's and NMS
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Side Effects of Traditional Antipsychotics |
1. Antidopaminergic- EPSE, hyperprolactinemia. Tx- decrease dose and administer anti meds 2. Anti-HAM effects 3. Weight gain 4. Increased liver enzymes 5. Ophthalamogic problems 6. Derm problems- rash and photosensitivity 7. Seizures 8. Tardive dyskinesia- writhing of mouth and tongue in patients that have used neuroleptics for > 6 mo (mostly increased in female) 9. NMS- MC in males early in tx, emergency, FALTER (fever, autonomic instability, leukocytosis, tremor, increase CPK, rigidity) |
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Atypical Antipsychotics |
More effective in treating negative symptoms (so 1st line of treatment of schizophrenia Clozapine (clozaril)- patients must have wkly WBCs to check for agranulocytosis Risperidone (Risperdal) Quetiapine (Seroquel)- may cause cataracts so slit lamp exam every 6 mo Olanzapine (Zyprexa)- hyperlipidemia, glucose intolerance, wt gain, liver toxicity Ziprasidone (geodon) Side effects-some anti-HAM |
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Mood stabilizers |
Used to tx acute mania and prevent relapses of manic episodes Less commonly- major depression, schizophrenia, enhancement of alcohol abstinence, tx of agg or impulsivity |
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Lithium |
Exact MOA is unknown, lithium is secreted by the kidney and OA takes 5-7 days Therapeutic range- 0.7-1.2, toxic >1.5, lethal 2.0 Side effects: fine tremor, sedation, ataxia, thirst, metallic taste, polyuria, edema, wt gain, GI problems, leukocytosis, thyroid enlargement, hypothyroidism, nephrogenic DI |
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Factors that affect Lithium levels |
NSAIDs (decrease) Aspirin Dehydration (increase) Salt deprivation (increase) Diuretics Impaired renal function |
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Carbamazepine (Tegretol) |
especially useful in treatment of mixed episodes and rapid-cycling bipolar, blocks Na+ channels and inhibits action potentials OA- 5-7 days Side effects: rash, drowsiness, ataxia, slurred speech, leukopenia, hyponatremia, aplastic anemia, agranulocytosis, teratogenic (neural tube defects) |
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Valproic acid (Depakene) |
Mixed manic and rapid cycling, increased CNS levels of GABA Side effects: sedation, wt gain, alopecia, hemorrhagic, pancreatitis, hepatoxicity, thrombocytopenia, neural tube defect |
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Anxiolytics/hypnotics |
depress the CNS Indications: anxiety, muscle spasms, seizures, sleep disorders, alcohol withdrawal, anesthesia induction |
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Benzodiazepine |
First line treatment Safety at high doses, but have potential for tolerance and dependence after prolonged use Potentiate the effects of GABA Side effects- Drowsiness, mental impairment, low motor coordination |
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Long acting BDZ |
1-3 days Chlordiazepoxide Diazepem (Valium)- rapid onset- anxiety and seizure control
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Intermediate Acting BDZ |
10-20 hours Alprazolam (xanax)- panic attacks Clonazepam (Klonopin)- panic attacks, anxiety Lorazepam (Ativan)- tx of panic attacks, alcohol withdrawal Temazepam (Restoril)- tx of insomnia |
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Short acting BDZ |
3-8 hours Oxazepam (Serax) Triazolam (Halcion)- rapid onset, insomnia |
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Buspirone (Buspar) |
Alternative to BDZ or venlafaxine for tx of GAD, slower OA (1-2 wks) Anxiolytic action is at 5HT-1A receptor doesn't potentiate CNS depression of ETOH |
